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Should emergency contraception be available directly from pharmacies?

Should emergency contraceptives be purchasable directly from pharmacies or should woman be required to obtain a prescription through a physician? Six states currently allow direct purchase.

Some people have argued that direct purchase will increase the rate of risk behavior thereby increasing pregnancies and STDs.

A study reported in the January 5, 2005 issue of the Journal of the American Medical Association found that women who have direct access to emergency contraceptives from pharmacies do not increase their risk behavior.

The researchers randomly assigned study participants into three groups: pharmacy access, advance provision, clinic provision after the fact. Participants were contacted 6 months after the start of the study to obtain information about their behavior.

Women in the pharmacy access group were no more likely to use emergency contraception than the women in the clinic provision group. Women in the advance provision group were twice as likely to use emergency contraception even though the rate of unprotected intercourse were similar. 8% of the study participants became pregnant, and 12% contracted an STD. (N=2,117 women aged 15 - 24)

The authors conclude

"While removing the requirement to go through pharmacists or clinics to obtain EC increases use, the public health impact may be negligible because of high rates of unprotected intercourse and relative underutilization of the method. Given that there is clear evidence that neither pharmacy access nor advance provision compromises contraceptive or sexual behavior, it seems unreasonable to restrict access to EC to clinics."

In other words pharmacy access does not increase risk behavior, and it does not increase the use of emergency contraception any more than clinic provision. However, advance provision did increase the use of emergency contraception without an increase in risk behavior.

So, it would appear that emergency contraception should be available through pharmamcies. It also appears that if the public health goal is to limit the number of unwanted pregnancies, advanced provision of emergency contraception would make it more likely that it would be used.

Link: JAMA -- Abstract: Direct Access to Emergency Contraception Through Pharmacies and Effect on Unintended Pregnancy and STIs: A Randomized Controlled Trial, January 5, 2005, Raine et al. 293 (1): 54.

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